10 Questions to Ask Before Hiring a Home Health Agency in Houston
Houston Home Care Editorial TeamApril 15, 2026
10 Questions to Ask Before Hiring a Home Health Agency in Houston
Choosing a home health agency is one of the most consequential decisions a family can make. You are trusting people you have never met to enter your home and care for someone you love. In the Houston metro area, there are more than 800 HCSSA-licensed agencies, and the quality varies enormously. Some agencies have deep experience, well-trained staff, and strong compliance records. Others have high turnover, thin training programs, and histories of complaints.
These 10 questions will help you evaluate any Houston home health agency before signing a service agreement. Ask every one of them.
1. Are You Licensed by Texas HHSC, and What Service Categories Do You Hold?
Every home health agency in Texas must hold an active HCSSA license from the Texas Health and Human Services Commission. The license specifies which service categories the agency is authorized to provide: LCHHS (skilled nursing, Medicare-certified), LHHS (skilled nursing, state-only), PAS (personal assistance), or Hospice.
Ask for the license number and verify it yourself through the Texas TULIP long-term care provider search. Check whether the license is current and whether the agency has had any enforcement actions.
Red flag: Any agency that cannot immediately produce their license number or does not clearly know their own service categories.
2. Is Your Agency Medicare-Certified?
This matters if the patient may qualify for Medicare home health coverage. Only agencies with LCHHS licensure and active CMS certification can bill Medicare. In the Houston metro, roughly 200 out of 800-plus agencies hold this certification.
Medicare certification also means the agency undergoes federal surveys and must meet quality standards monitored by CMS. You can look up any Medicare-certified agency's quality ratings, patient survey results, and inspection history on Medicare Care Compare.
Continue Comparing Care Options
Use the directory paths below to move from research into a short list of Houston-area providers.
Even if you are not using Medicare right now, choosing a Medicare-certified agency means selecting a provider that meets a higher regulatory standard.
3. What Background Checks Do You Run on Caregivers?
Texas HHSC requires home health agencies to conduct criminal background checks on employees through the Employee Misconduct Registry (EMR) and the Nurse Aide Registry (NAR). But the depth of screening beyond those minimums varies.
Ask whether the agency runs a Texas Department of Public Safety criminal history check, a national criminal database search, a sex offender registry check, verification of the Employee Misconduct Registry for any findings of abuse, neglect, or exploitation, and verification of professional licenses for nurses and therapists through the Texas Board of Nursing.
Some agencies also run drug screening, driving record checks (important if the caregiver will drive your loved one), and reference checks with previous employers.
Red flag: An agency that only checks the state-mandated minimum registries and performs no additional screening.
4. How Do You Train and Supervise Caregivers?
Ask about both initial training and ongoing education. For LCHHS and LHHS agencies, ask how often a supervising RN visits the home. Texas regulations require supervisory visits at regular intervals, but the best agencies exceed minimums and conduct visits every two to four weeks.
For PAS agencies, ask what training attendants receive before their first client assignment. Strong agencies train on fall prevention, dementia care techniques, infection control, emergency response, and individualized care plans. Ask whether attendants receive annual continuing education.
Also ask who develops the care plan and how often it is reviewed. The best agencies conduct a thorough in-home assessment, create a written care plan, share it with the family, and update it at least quarterly.
5. Will We Have Consistent Caregivers?
Consistency matters enormously, especially for clients with dementia, anxiety, or complex daily routines. Ask whether the agency assigns a primary caregiver and how many different people you should expect in a typical month.
Staff turnover is one of the most persistent problems in home health care. Agencies that pay better wages, provide benefits, and foster a supportive work environment retain caregivers longer — and that directly translates to more stable care for clients.
Ask directly: What is your annual caregiver turnover rate? An agency with turnover below 40 percent is doing well by industry standards. Above 60 percent is a warning sign. Many agencies will not share this number, which is itself informative.
6. What Happens If Our Regular Caregiver Cannot Make It?
Every agency deals with sick days, emergencies, and schedule conflicts. The difference between a good agency and a bad one is the backup plan.
Ask how much advance notice you will get if a caregiver is unavailable. Ask whether the agency guarantees a replacement or simply cancels the visit. Ask whether the backup caregiver will have access to your loved one's care plan before they arrive.
Some agencies maintain a dedicated relief pool for coverage. Others scramble to find replacements day-of and leave families without care.
Red flag: An agency that admits they sometimes cannot fill shifts and offers a refund instead of a replacement.
7. What Is Your Complaint and Incident Resolution Process?
Problems will happen. What matters is the response. Ask whether the agency has a designated person who handles complaints, what the expected response time is, whether complaints are documented and tracked, and whether you will receive a written resolution.
Texas HHSC requires agencies to maintain a grievance process and inform clients of their right to file complaints directly with HHSC. A quality agency will have a clear written procedure and will walk you through it without hesitation.
You can also check an agency's complaint and inspection history through the Texas TULIP long-term care provider search. Ask the agency directly whether they have had any HHSC complaints or enforcement actions in the past two years.
8. What Does Your Pricing Include?
Get the complete financial picture in writing before signing anything. Ask about the hourly rate and whether it changes for evenings, weekends, or holidays. Ask about the minimum visit length — most agencies require 3 to 4 hours — and whether you are billed for the minimum even if the visit runs shorter. Ask about assessment fees, care plan fees, after-hours surcharges, mileage charges, or cancellation penalties.
For LCHHS agencies billing insurance, ask about your expected copay or coinsurance, and whether the agency bills insurance directly or requires upfront payment.
Get quotes from at least three agencies and ask for the same scope of care in writing so you can compare rates honestly.
9. What Insurance Do You Accept?
This question alone can narrow your search significantly. Ask whether the agency accepts Medicare (LCHHS agencies only), Medicaid STAR+PLUS managed care, STAR Kids, Community First Choice, and your commercial insurance plan by name.
For Medicaid managed care, ask specifically which MCOs the agency is contracted with — Molina, Superior, Amerigroup, or UnitedHealthcare. Being licensed does not mean being enrolled in every MCO network.
If the agency does not accept your insurance, ask whether they provide a superbill for out-of-network reimbursement.
10. Can You Provide References From Current or Recent Clients?
A reputable agency should be willing to connect you with families who can speak to their experience. Ask for two to three references, ideally from clients with care needs similar to yours — for instance, dementia care or post-surgical recovery.
When speaking with references, ask how long they have used the agency, whether caregivers have been consistent, how the agency handled any problems, and whether they would recommend the agency to a family member.
Online reviews are another source of perspective, but the most authoritative public data usually comes from Medicare Care Compare and the state licensing record.
Bonus: Questions to Ask Yourself
Beyond evaluating agencies, consider your family's own situation. How many hours per week does your loved one need care? Does the need require skilled nursing (LCHHS) or personal assistance (PAS)? What is your budget, and have you checked eligibility for Medicare, STAR+PLUS, or VA benefits? Are there language preferences — many Houston agencies offer bilingual care in Spanish? Which neighborhoods need to be covered? An agency based in Katy may not routinely serve Kingwood.
Start Your Search
With more than 800 agencies in the Houston metro area, finding the right one takes homework. But asking these 10 questions systematically will separate the agencies that are truly worth your trust from those that are not.
Browse agencies in our directory, filter by service category, neighborhood, insurance, and specialty, and contact agencies directly to begin the conversation.
